Infections of the Reproductive Tract Flashcards
Describe the epidemiology of STI patients
- Age - 15-24
- Ethnicity
- Socio-economic status - poorer people
- Age at first sexual intercourse - younger
- Number of partners
- Sexual orientation - gay men more likely
- Condom use
What are causes of vaginal discharge
- Chlamydia
- Gonorrhoea
- Trichomonas vaginalis - yellow/green
- Bacterial vaginosis - thin, milky white
- Vulvovagina candidiasis - thick, white
- Herpes
What are causes of genital ulceration
- Herpes
- Syphilis
What are causes of urethral discharge
- Gonorrhoea
- Chlamydia
- Trichomonas vaginalis
- Herpes
- HPV (warts)
How can you test for UTI in men
- Urine analysis
- Gonorrhoea and chlamydia from nucleic acid amplification testing (NAAT) - PCR
- Urethral sampling
- Gonorrhoea cultures
- Gram stain microscopy
- Rectal and pharyngeal samples
- Gonorrhoea and chlamydia NAAT
- Swab of ulcer base
- Herpes simplex virus, syphilis
- Bloods
- Syphilis and blood born viral infections
How can you test for UTI in women
- Triple swab test:
- High vaginal swab
- Bacterial vaginosis, trichomonas vaginalis, candida, group B strep
- 2 endocervical swabs
- Gonorrhoeae and chlamydia
- Vulvovaginal swabs
- Gonorrhoea, chlamydia NAAT
- Urine
State the organism that causes chlamydia
Chlamydia trachomatis
Describe the presentation of chlamydia
- Presentation in males - asymptomatic, urethritis, dysuria, prostatitis
- Presentation in females - asymptomatic, urethra discharge, vaginal discharge
Describe diagnosis and treatment of chlamydia
- Diagnosis
- Vulvovaginal and endocervical swabs for NAAT
- First catch urine NAAT - for men and women
- Urethral swabs
- Treatment
- Doxycycline and azithromycin
State the organism that causes gonorrhoea
- Neisseria gonorrhoeae
- Gram negative diplococcus
Describe the presentation of gonorrhoea
- Men - urethral discharge, dysuria
- Women - asymptomatic, vaginal discharge, lower abdominal pain
Describe the diagnosis and treatment for gonorrhoea
- Diagnosis
- Gram stain from endocervical, vulvovaginal and urethral swabs
- Treatment
- IM ceftriaxone + oral azithromycin
- Taken together as it boosts effect of ceftriaxone, decreases resistance to ceftriaxone and treat other possible infections such as chlamydia
- IM ceftriaxone + oral azithromycin
State the organism that causes genital herpes
- Herpes simplex virus (HSV) 1 & 2
- HSV1 - usual cause of oro-labial herpes
- HSV2 - more likely to cause recurrent symptoms
- HSV1 - usual cause of oro-labial herpes
Describe the presentation of herpes
Asymptomatic, vaginal discharge, painful ulceration
Describe the diagnosis and treatment for herpes
- Diagnosis - swab of ulcer base
- Type specific serology - look for HSV antibodies which occurs if previous infection has happened
- Treatment - Acyclovir (anti-viral)
State the organism that causes genital warts
Human papillomavirus (HPV)
Describe the treatment of genital warts
Normally no treatment needed, topical application
Describe the presentation of syphilis
- Rash and painless ulcers first few weeks which disappears as bacteria enters latent stage
- Up to 40 years later, may infect again
- Not infectious in men, women can easily transmit to fetus (congenital syphilis)
- Up to 40 years later, may infect again
Describe the diagnosis and treatment of syphilis
- Diagnosis - blood tests - Treatment
- Early stage - penicillin
- Late stage - antibiotics such as azithromycin
- Early stage - penicillin
Describe the presentation of trichomonas vaginalis
- Men - urethral discharge, dysuria
- Women - vaginal discharge - green/yellow, frothy
Describe the diagnosis and treatment of trichomonas vaginalis
- Diagnosis - high vaginal swab
- Treatment - metronidazole
State genital infections that are not STI
- Scabies/pubic lice
- Bacterial vaginosis
- Vulvovaginal candidiasis
Describe the presentation and treatment of scabies
- Symptoms - itching and rash
- Treatment - permethrin
Describe the cause and presentation of bacterial vaginosis
- Commonest cause of abnormal discharge in women of childbearing age
- Abnormal vaginal pH stimulates growth of bacterial vaginosis
- Causes - douching, partner change, smoking
- Fishy discharge, no itchiness
Describe the diagnosis and treatment of bacterial vaginosis
- Diagnosis - high vaginal swab
- Treatment - metronidazole
Describe the cause and presentation of vulvovaginal candidiasis
- Organism - mostly Candida albicans
- Grow when vaginal environment such as pH altered where lactobacilli become replaced
- Antibiotics, oestrogen oral contraceptives (oestrogen increases vaginal pH)
- Grow when vaginal environment such as pH altered where lactobacilli become replaced
- Present with vaginal discharge - thick, white
Describe the diagnosis and treatment of vulvovaginal candidiasis
- Diagnosis - high vaginal smear
- Treatment - topical and oral azoles, antifungals
Describe the pathophysiology of pelvic inflammatory disease
- Ascending infection from the endocervix and vagina
- Infection causes inflammation, which damages Fallopian tube epithelium and cause adhesions to form
- Endometritis - inflammation of the endometrium
- Salpingitis - inflammation of the Fallopian tubes
- Forms exudate that fills tube with pus
- Can cause abscess and fibrosis within the tubule
- Tubo-ovarian abscess - abscess forming in the tubule and ovaries
- Potentially life-threatening if ruptured - sepsis
State the causes of PID
- Neisseria gonorrhoea
- Chlamydia trachomatis
- Bacterial vaginosum
- Copper coil
Describe the presentation of PID
- Pyrexia, lower abdominal pain, abnormal vaginal discharge/bleeding
- Examination - pyrexia, lower abdominal tenderness normally bilateral
Describe the complications of PID
- Ectopic pregnancy
- Infertility
- Chronic pelvic pain
- Fitz-Hugh-Curtis syndrome - right upper quadrant pain following chlamydia
